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Macular Degeneration

February 2009

MACULAR DEGENERATION

As we get older, our eyesight changes. Most of us know that sinking feeling of visiting the opticians and being told we now need reading glasses – a sure sign of passing years.

What is worse is when we are told we have the first signs of macular degeneration. Age related macular degeneration, or AMD, is one of the biggest causes of severe sight loss in older people. Currently around 25% of people over 60 in the UK suffer from some level of AMD and over 14 million people in Europe are classified blind because of it.

While it is a major problem, AMD doesn’t necessarily lead to total blindness. There is often enough peripheral vision for people to keep some level of independence in their lives. Women are more likely to suffer than men.

So what is it and what can we do about it?

There are two different types of AMD, dry and wet. Most sufferers – around 90% - are affected by dry macular degeneration but there is also a significant number of people suffering from wet macular degeneration among the over 60s.

To understand about the problem, you need to know a little about the eye.

Light coming in via the pupil and lens reaches the retina at the back of the eye. The retina changes the light into images and sends them down the optic nerves to the brain. At the very centre of the retina is a small area which specifically helps us see fine details and colour. This is called the macula.

For various reasons, the very delicate cells of the macula can become damaged or stop working.Dry AMD develops slowly. The visual cells gradually stop functioning and die, causing loss of central vision. In the early stages your central vision may become blurred or distorted, with objects looking an unusual size or shape and straight lines appearing wavy or fuzzy. Colours can begin to look faded. There is no pain associated with AMD.

Because AMD affects the centre of the retina, in more advanced stages sufferers will often notice a blank patch or dark spot in the centre of their sight. This makes reading, writing and recognising small objects or faces very difficult.

Wet AMD results in new blood vessels growing behind the retina which can cause bleeding and scarring. This can develop quite quickly leading to sight loss.

Usually both eyes are affected, but not always at the same rate. This means that you may not notice the initial deterioration of sight in one eye because the other eye is compensating.

Currently there are no treatments for dry AMD but there is some help for wet AMD. This can include photodynamic therapy, when a light sensitive drug is added to your blood stream to pinpoint the new blood vessels that have grown behind the retina. Then a special laser is shone into the eye which activates the drug and stops the new vessels growing and damaging the macular. However, it doesn’t work with all wet AMD cases.

The good news is that health experts and scientists are working on ways to try and treat AMD and already there are some exciting test results.

An early sign of AMD is the formation of microscopic structures called drusen in the eye. New research has found that drusen in eyes with AMD contain very high levels of zinc. Zinc is essential to our health and helps keep molecules in shape, but free zinc can cause problems. More research is now being carried out at the Experimental Eye Research under the London Institute of Ophthalmology but drugs are already being developed that can capture free zinc.

A team from Moorfields Eye Hospital in London is carrying out research on transplanting retinal cells. They are taking cells from the health periphery of the eye in patients with wet AMD and transplanting them into the affected area.

So there is good news and definite hope on the horizon. There is also a lot of support available for suffered for both forms of AMD. Another useful website is: www.rnib.org.uk